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Supreme Court limits forced medication of non-violent defendants

Ruling on Missouri case seen as curb for prosecutors

From Bill Mears
CNN's Washington Bureau

Ruling on Missouri case seen as curb for prosecutors

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WASHINGTON (CNN) -- The Supreme Court Monday limited government efforts to force drugs on most psychotic criminal defendants, a setback for prosecutors trying to convict the mentally ill.

At issue was whether non-violent defendants may be forcibly medicated in order to render them competent to stand trial.

In a 6-3 ruling, the justices said such anti-psychotic drugs can be used only in "limited circumstances."

The case involves Dr. Thomas Sell, who along with his wife was accused in 1997 of Medicaid fraud and money laundering. Sell had a history of mental illness, and psychiatrists who examined him after his arrest noted an increasing occurrence of psychotic episodes. At a 1998 court appearance, Sell, a St. Louis, Missouri, resident, allegedly spit at a federal magistrate and shouted racial slurs. He was later charged with conspiring to murder a witness and an FBI agent.

Psychiatrists testified that Sell, 53, suffers from a "delusional disorder of the persecutory type" and "could become a danger to himself and others."

A court ruled Sell incompetent to assist in his defense, and he was later ordered to take anti-psychotic medication. Sell appealed, and he has spent the past five years in detention while the case worked its way through the legal system. He has yet to stand trial for any of the charges against him.

Justice Stephen Breyer, writing for the majority, set a high legal standard for the government to follow when pursuing cases such as Sell's.

"Has the government, in light of the efficacy, the side effects, the possible alternatives, and the medical appropriateness of a particular course of antipsychotic drug treatment, shown a need for that treatment sufficiently important to overcome the individual's protected interest in refusing it," asked Breyer, who concluded the government in Sell's case had not met that burden.

But in his dissent, Justice Antonin Scalia said the accused could exploit legal loopholes to escape punishment. "Today's narrow holding will allow criminal defendants ... to engage in opportunistic behavior. They can, for example, voluntarily take their medication until halfway through trial, then abruptly refuse and demand an interlocutory from the order that medication continue on a compulsory basis."

Sell's lawyers told the justices their client is "legally incompetent but not mentally incompetent," meaning despite his delusions, Sell acts rationally enough to know he does not want to be given anti-psychotic drugs, fearing possible side-effects.

Forced medication a form of censorship, ethicists claim

Sell's doctors said his behavior has grown increasingly erratic over the years, aggravated, they claimed, by his incarceration and his fears the FBI is out to get him. His lawyers argued forced medication were not the right choice and would violate his right to control his body.

"A mentally incompetent individual will lose his right to refuse medication based solely on the government's unproven assertion that the individual is guilty of a nonviolent crime," said Barry Short, Sell's attorney.

A number of medical ethicists supported Sell's claim, calling forced medication of non-violent defendants "cognitive censorship." They said the government should not be allowed to drug someone it is opposing in court.

U.S. government attorney Michael Dreeben, however, told the justices the government has "no option but to restore competency" to Sell and said forced medication would actually help Sell in his defense, since he would be able to communicate effectively with counsel.

The Justice Department released figures showing every year hundreds of defendants facing federal charges are medicated, most willingly, and the majority become competent to stand trial. Fifty-nine people were forcibly medicated in a recent one-year period, and about three-fourths of them were rendered competent, according to the government.

Forced medication of defendants has been allowed for a number of years, but usually for those accused of serious, violent crimes. A 1992 court ruling also said forced drugging can be done if deemed medically appropriate.

An example is Russell Weston, accused of a shooting spree in the U.S. Capitol building in 1998 that left two police officers dead. Doctors say his mental condition is improving after being ordered more than a year ago to take antipsychotic medicine. He could face trial this fall.

The case is Sell v. U.S., no. 02-5664.

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